Provider Information for 1992251862
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SHAQUIL JONES
Sex: Male
NPI: 1992251862
Last Updated: 2023-04-14
Certification Date: 2023-04-14
Certification Date: 2023-04-14
Details
| Name | Value | ||||||||||||||||
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| NPI | 1992251862 | ||||||||||||||||
| Enumeration Date | 2016-08-30 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 3904 LA MESA AVE SHASTA LAKE, CA 96019-9210 United States Phone: 510-901-9583 | Fax: | ||||||||||||||||
| Primary Practice Address | 1170 INDUSTRIAL ST REDDING, CA 96002-0734 United States Phone: 530-722-9957 | Fax:530-722-9294 | ||||||||||||||||
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